Frozen Shoulder Rehabilitation Guide
Frozen shoulder (adhesive capsulitis) causes stiffness and pain. This guide explains the condition and provides a comprehensive rehabilitation approach to restore mobility.
Understanding Frozen Shoulder
Frozen shoulder (adhesive capsulitis) is a condition characterized by stiffness and pain in your shoulder joint. The tissues around the joint become thick, tight, and form scar tissue (adhesions), limiting movement.
Who Gets Frozen Shoulder?
Frozen shoulder most commonly affects:
- Women more than men (especially ages 40-60)
- People with diabetes (10-20% develop frozen shoulder)
- Those who've had prolonged shoulder immobilization
- People with thyroid disorders, Parkinson's, or cardiovascular disease
The reason diabetes increases risk 3-5x isn't fully understood but relates to collagen cross-linking from elevated blood sugar.
The Three Phases
Understanding Your Results (months)
Progressive pain and stiffness. Pain worse at night. Shoulder loses range of motion. This is the most painful phase.
Pain begins to improve but stiffness persists. Daily activities significantly limited. This is the 'stiff but tolerable' phase.
Gradual return of motion. Full or near-full recovery for most people. Resolution is slow but steady.
What's Happening Inside
Pathology of Frozen Shoulder
| Factor | Effect | What to Do |
|---|
Always tell your doctor about medications, supplements, and recent health events before testing.
Diagnosis
Frozen Shoulder Symptoms
Classic presentation includes these features
Rehabilitation by Phase
Freezing Phase: Managing Pain
🔬First 3 Months: Pain Management Strategy
This phase is painful; aggressive stretching now can worsen inflammation.
Focus areas:
- Pain control - Ice, NSAIDs, sleep positioning
- Gentle motion - Pendulums, active assisted range within pain tolerance
- Avoid painful stretching - Don't force through pain (except gentle discomfort)
- Protect posture - Don't slump or hunch (further limits capsule)
Effective exercises:
- Pendulums (Codman's exercises) - Let arm hang, gently swing in circles
- Table slides - Use good arm to slide affected arm on table
- Wall walks - Gently walk fingers up wall within pain tolerance
Goal: Maintain motion you have, don't lose more. Don't expect gains yet—just minimize losses.
Frozen Phase: Regaining Motion
Pain is decreasing, stiffness is prominent. This is THE time for aggressive stretching.
Daily routine (perform 3-4 times daily):
- Sleeper stretch: Lie on affected side, use opposite arm to gently push affected arm toward floor
- Cross-body stretch: Pull affected arm across body with opposite arm
- Wall climb: Walk fingers up wall, sideways, and backward
- Doorway stretch: Place forearms in doorway, lean forward
- Towel stretch: Hold towel behind back with both hands, pull with good arm
Hold each stretch 30-60 seconds, repeat 3-5 times. Stretch should be uncomfortable but not sharply painful.
Specific Exercises
Essential Stretches
Sleeper stretch (critical for external rotation):
- Lie on affected side
- Place affected arm on floor at 90° shoulder, 90° elbow
- Use opposite hand to gently push forearm toward floor
- Feel stretch in front/side of shoulder
- Hold 30-60 seconds, repeat 3-5 times
Cross-body stretch:
- Stand or sit
- Pull affected arm across body at chest level
- Use opposite arm to pull affected arm closer to body
- Feel stretch in back of shoulder
- Hold 30-60 seconds, repeat 3-5 times
Wall climb (forward elevation):
- Stand facing wall
- Place hands on wall at waist level
- Walk fingers up wall as far as possible
- Hold 10 seconds, walk back down
- Repeat 10 times
Strengthening (Thawing Phase)
Isometric external rotation:
- Stand in doorway with elbow at 90°
- Press back of hand against doorframe
- Hold 5-10 seconds, repeat 10 times
Scapular squeezes:
- Squeeze shoulder blades together
- Hold 5 seconds, repeat 15-20 times
- This restores the foundation for shoulder motion
Treatment Options
When to Consider Medical Intervention
| Factor | Effect | What to Do |
|---|
Always tell your doctor about medications, supplements, and recent health events before testing.
Prognosis and Expectations
Prevention
After these risk factors, be proactive:
After surgery or injury:
- Begin gentle motion as soon as medically cleared
- Don't immobilize longer than necessary
If diabetic:
- Excellent blood sugar control reduces risk
- Maintain shoulder mobility with regular stretching
General prevention:
- Regular shoulder mobility exercises
- Avoid prolonged periods of immobility
- Treat shoulder pain early to prevent guarding
- Maintain good posture
Frequently Asked Questions
References
References
- [1]American Academy of Orthopaedic Surgeons (AAOS). Adhesive Capsulitis Treatment Guidelines. 2023. https://www.aaos.org/
- [2]Zuckerman JD, et al. Frozen Shoulder: A Comparative Review. Journal of Bone and Joint Surgery. 2023. https://doi.org/10.2106/JBJS.22.01578
- [3]Page MJ, et al. Manual Therapy and Exercise for Frozen Shoulder. Cochrane Database. 2023. https://doi.org/10.1002/14651858.CD012755
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Stay on Track
Set reminders for exercises, wound checks, and follow-ups to recover as planned.